Increased frequency of metabolic syndrome among Vietnamese women with early rheumatoid arthritis: a cross-sectional study.

Hanh-Hung Dao,Quan-Trung Do,Junichi Sakamoto

doi:10.1186/ar3203

Hanh-Hung Dao, Quan-Trung Do + Show 1 more

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https://doi.org/10.1186/ar3203

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Abstract

IntroductionRheumatoid arthritis (RA) is associated with increased morbidity and mortality due to cardiovascular disease, and this occurs early in the disease process. The metabolic syndrome (MetS) may contribute to the excess cardiovascular burden observed in RA; however, little information is available regarding MetS in early RA. We aimed to identify the prevalence of MetS and to determine the potential factors associated with the presence of MetS in Vietnamese women with early RA.MethodsA total of 105 consecutive women with early RA (disease duration ≤3 years) and 105 age-matched healthy women were checked for MetS according to six MetS definitions (Joint Consensus, International Diabetes Federation, National Cholesterol Education Program 2004 and 2001, European Group for Study of Insulin Resistance, and World Health Organization). Multivariate logistic regression models were constructed to determine independent predictors of MetS in women with RA.ResultsPrevalence of MetS varied from 16.2% to 40.9% according to the definitions used in women with RA, and was higher (P < 0.001) than in healthy controls (from 10.5% to 22.9%). Among individual components of MetS, differences between women with RA and controls were observed for hypertension (P < 0.001), low high density lipoprotein-cholesterol (HDL-C) levels (P < 0.001), and abdominal obesity (P = 0.019). After adjusting for age and physical activity, higher erythrocyte sedimentation rate (ESR) (odds ratios (OR) = 1.516, 95% confidence interval (CI): 1.073 to 3.195, P = 0.042), disease activity score (DAS28) (OR = 1.736, 95% CI: 1.293 to 2.786, P = 0.019), health assessment questionnaire (HAQ) score (OR = 1.583, 95% CI: 1.195 to 2.367, P = 0.035), and less methotrexate use (OR = 0.736, 95% CI: 0.547 to 0.962, P = 0.024) remained significant independent predictors of the presence of MetS in women with RA.ConclusionsWomen with early RA already had higher prevalence of MetS compared with healthy controls. Higher systemic inflammatory marker, disease activity and disability scores, and less methotrexate use were independent predictors associated with the presence of MetS in women with early RA. These findings suggest that physicians should screen for MetS in women with early RA to control its components and therefore reduce their risk of cardiovascular diseases.

Highlights

Rheumatoid arthritis (RA) is associated with increased morbidity and mortality due to cardiovascular disease, and this occurs early in the disease process
We found that among individual components of metabolic syndrome (MetS), differences between women with RA and controls were observed for hypertension, low high density lipoprotein-cholesterol (HDL)-C levels, and abdominal obesity
We found total cholesterol (TC) levels were similar between the two groups while the atherogenic index (TC/high-density lipoprotein cholesterol (HDL-C) ratio) and low density lipoprotein (LDL)-C levels were higher in women with RA

Summary

Introduction

Rheumatoid arthritis (RA) is associated with increased morbidity and mortality due to cardiovascular disease, and this occurs early in the disease process. Rheumatism (EULAR) guidelines recommend that cardiovascular risk screening and management strategies are urgently needed in patients with RA [5] Such strategies are generally done on the basis of a cardiovascular risk score calculator, such as the Framingham score (often used in the United States) [6] and the Systemic Coronary Risk Evaluation (SCORE) model (often used in Europe) [7]. In these models, traditional cardiovascular risk factors such as age, gender, smoking status, blood pressure (BP), cholesterol and high-density lipoprotein cholesterol (HDL-C) levels are integrated [5,6,7,8]. Traditional cardiovascular risk factors such as hypertension [2,9], central obesity [10,11], dyslipidaemia [12,13], and insulin resistance [14,15,16] may occur more frequently among patients with RA, this does not fully account for the rates of CVD observed [17], novel risk factors, systemic inflammation, have been implicated [18]

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